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Franz B, Cronin CE, Lindenfeld Z, Pagan JA, Lai AY, Krawczyk N, Rivera BD, Chang JE. Rural-urban disparities in the availability of hospital-based screening, medications for opioid use disorder, and addiction consult services. J Subst Use Addict Treat 2024; 160:209280. [PMID: 38142042 PMCID: PMC11060933 DOI: 10.1016/j.josat.2023.209280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/07/2023] [Accepted: 12/15/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Hospitals are an ideal setting to stage opioid-related interventions with patients who are hospitalized due to overdose or other substance use-related complications. Transitional opioid programs-which initiate care and provide linkages upon discharge, such as screening, initiation of medications for opioid use disorder, and addiction consult services-have become the gold standard, but implementation has been uneven. The purpose of this study was to assess disparities in the availability of hospital-based transitional opioid programs, across rural and urban hospital settings in the United States. METHODS Using hospital administrative data paired with county-level demographic data, we conducted bivariate and regression analyses to assess rural-urban differences in the availability of transitional opioid services including screening, addiction consult services, and MOUD in U.S general medical centers, controlling for hospital- and community-level factors. Our sample included 2846 general medical hospitals that completed the 2021 American Hospital Association (AHA) Annual Survey of Hospitals. Our primary outcomes were five self-reported measures: whether the hospital provided screening in the ED; provided screening in the inpatient setting; whether the hospital provided addiction consult services in the ED; provided addiction consult services in the inpatient setting; and whether the hospital provided medications for opioid use disorder. RESULTS Rural hospitals did not have lower odds of screening for OUD or other SUDs than urban hospitals, but both micropolitan rural counties and noncore rural counties had significantly lower odds of having addiction consult services in either the ED (OR: 0.74, 95 % CI: 0.58, 0.95; OR: 0.68, 95 % CI: 0.50, 0.91) or inpatient setting (OR: 0.76, 95 % CI: 0.59, 0.97; OR: 0.68, 95 % CI: 0.50, 0.93), respectively, or of offering MOUD (OR: 0.69, 95 % CI: 0.52, 0.90; OR: 0.52, 95 % CI: 0.37, 0.74). CONCLUSIONS Our study suggests that evidence-based interventions, such as medications for opioid use disorder and addiction consult services, are less often available in rural hospitals, which may contribute to rural-urban disparities in health outcomes secondary to OUD. A priority for population health improvement should be developing implementation strategies to support rural hospital adoption of transitional opioid programs.
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Affiliation(s)
- Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Appalachian Institute to Advance Health Equity Science (ADVANCE), United States of America.
| | - Cory E Cronin
- Ohio University College of Social and Public Health, Appalachian Institute to Advance Health Equity Science (ADVANCE), United States of America
| | - Zoe Lindenfeld
- New York University College of Global Public Health, United States of America
| | - Jose A Pagan
- New York University College of Global Public Health, United States of America
| | - Alden Yuanhong Lai
- New York University College of Global Public Health, United States of America
| | - Noa Krawczyk
- New York University Grossman School of Medicine, United States of America
| | - Bianca D Rivera
- New York University Grossman School of Medicine, United States of America
| | - Ji E Chang
- New York University College of Global Public Health, United States of America
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Boutouis S, Wymbs F, Franz B. The association between marijuana and e-cigarette use and exercise behavior among adults. Prev Med Rep 2024; 40:102668. [PMID: 38469398 PMCID: PMC10926305 DOI: 10.1016/j.pmedr.2024.102668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/26/2024] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
Background As the prevalence of marijuana and e-cigarette use among American adults rises and the perceived risk decreases, more information is needed on the potential costs and benefits of marijuana and e-cigarette use, including patterns of exercise. Prior studies have found mixed results, lacked data on types of exercise, and involved only adolescents and young adults. Thus, the current study explored whether marijuana and e-cigarette use are associated with strength training, walking for exercise, or general physical activity among adults in the United States. Method 2,591 adults from Wave V of the National Longitudinal Study of Adolescent to Adult Health (2016-2018) comprised the sample. Separate one-way analyses of variance (ANOVAs) and post hoc tests examined whether participants' marijuana and e-cigarette use predicted their exercise, while follow-up analyses of covariance (ANCOVAs) probed significant effects. Results Results indicated that participants' marijuana and e-cigarette use predicted their walking for exercise, with marijuana users walking the highest number of times per week, followed by non-users, e-cigarette users, and dual users. However, this effect only approached significance after controlling for covariates. There were no significant differences in strength training or general exercise between groups. Conclusion These findings challenge the stereotype that marijuana and e-cigarette users are less active than non-users, and future research should examine the potential mechanisms of these findings.
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Vagedes R, Franz B, Kerr A, Wymbs F, Smith C, Rodgers A, Nandyal S, Strawhun D, Kropf K, Casapulla S. A Professional Development Workshop: Applying the Race and Culture Guide to Reduce Bias in Medical Teaching Cases. PRiMER 2024; 8:10. [PMID: 38681813 PMCID: PMC11051698 DOI: 10.22454/primer.2024.463730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Introduction Clinical teaching cases are a cornerstone of health professions education programs, but cases historically have lacked diversity and have the potential to reinforce essentialism. In this article, we describe the creation, implementation, and feasibility assessment of a professional development workshop aimed at integrating an existing bias reduction tool into discussion and revision of teaching cases. Methods Six 60-minute workshops were held introducing "The Race and Culture Guide for Editors of Teaching Cases" to different health profession education programs wherein all participants worked in small groups to critique and edit two sample teaching cases. To assess initial feasibility, facilitators completed a facilitator evaluation survey to capture experiences after the first three workshops. Due to positive feedback, workshops were continued, and participants completed a participant evaluation survey to understand learner impact. Results Facilitators (n=6) identified the workshop as addressing an important need, highlighted the value in small-group format, and noted their ability to facilitate future sessions. Participants (n=18) rated the workshop as useful, effective at challenging biases, and would recommend the workshop to others. Conclusion The purpose of this study was to understand the feasibility of implementing a discussion-based workshop integrating a bias reduction tool. Initial feasibility and acceptability assessments demonstrate that this workshop.
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Affiliation(s)
- Ryan Vagedes
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Berkeley Franz
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Anna Kerr
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Frances Wymbs
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Chynna Smith
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Alicia Rodgers
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Samantha Nandyal
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - David Strawhun
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Katy Kropf
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Sharon Casapulla
- Office of Rural and Underserved Programs, and Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
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Krawczyk N, Rivera BD, Chang JE, Lindenfeld Z, Franz B. Initiatives to Support the Transition of Patients With Substance Use Disorders From Acute Care to Community-based Services Among a National Sample of Nonprofit Hospitals. J Addict Med 2024; 18:115-121. [PMID: 38015653 PMCID: PMC10939963 DOI: 10.1097/adm.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND Hospitals are a key touchpoint to reach patients with substance use disorders (SUDs) and link them with ongoing community-based services. Although there are many acute care interventions to initiate SUD treatment in hospital settings, less is known about what services are offered to transition patients to ongoing care after discharge. In this study, we explore what SUD care transition strategies are offered across nonprofit US hospitals. METHODS We analyzed administrative documents from a national sample of US hospitals that indicated SUD as a top 5 significant community need in their Community Health Needs Assessment reports (2019-2021). Data were coded and categorized based on the nature of described services. We used data on hospitals and characteristics of surrounding counties to identify factors associated with hospitals' endorsement of transition interventions for SUD. RESULTS Of 613 included hospitals, 313 prioritized SUD as a significant community need. Fifty-three of these hospitals (17%) offered acute care interventions to support patients' transition to community-based SUD services. Most (68%) of the 53 hospitals described transition strategies without further detail, 23% described scheduling appointments before discharge, and 11% described discussing treatment options before discharge. No hospital characteristics were associated with offering transition interventions, but such hospitals were more likely to be in the Northeast, in counties with higher median income, and states that expanded Medicaid. CONCLUSIONS Despite high need, most US hospitals are not offering interventions to link patients with SUD from acute to community care. Efforts to increase acute care interventions for SUD should identify and implement best practices to support care continuity.
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Affiliation(s)
- Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine
| | - Bianca D. Rivera
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine
| | - Ji E. Chang
- Department of Public Health Policy and Management, New York University School of Global Public Health
| | - Zoe Lindenfeld
- Department of Public Health Policy and Management, New York University School of Global Public Health
| | - Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine; Appalachian Institute to Advance Health Equity Science (ADVANCE)
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Cronin CE, Kubacki L, Donovan L, Puro N, Lavinder D, Schuller K, Franz B. Alignment of substance use community benefit prioritization and service lines in US hospitals: a cross-sectional study. Addict Sci Clin Pract 2024; 19:11. [PMID: 38351004 PMCID: PMC10865679 DOI: 10.1186/s13722-024-00442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Non-profit hospitals in the U.S. are required by the 2010 Patient Protection and Affordable Care Act (ACA) to conduct a community health needs assessment (CHNA) every three years and to formulate an implementation strategy in response to those needs. Hospitals often identify substance use as a need relevant to their communities in their CHNAs and then must determine whether to create strategies to address such a need within their implementation strategies. The aim of this study is to assess the relationship between a hospital's prioritization of substance use within its community benefit documents and its substance use service offerings, while considering other hospital and community characteristics. METHODS This study of a national sample of U.S. hospitals utilizes data collected from publicly available CHNAs and implementation strategies produced by hospitals from 2018 to 2021. This cross-sectional study employs descriptive statistics and multivariable analysis to assess relationships between prioritization of substance use on hospital implementation strategies and the services offered by hospitals, with consideration of community and hospital characteristics. Hospital CHNA and strategy documents were collected and then coded to identify whether the substance use needs were prioritized by the hospital. The collected data were incorporated into a data set with secondary data sourced from the 2021 AHA Annual Survey. RESULTS Multivariable analysis found a significant and positive relationship between the prioritization of substance use as a community need on a hospital's implementation strategy and the number of the services included in this analysis offered by the hospital. Significant and positive relationships were also identified for five service categories and for hospital size. CONCLUSIONS The availability of service offerings is related both to a hospital's prioritization of substance use and to its size, indicating that these factors are likely inter-related regarding a hospital's sense of its ability to address substance use as a community need. Policymakers should consider why a hospital may not prioritize a need that is prevalent within their community; e.g., whether the organization believes it lacks resources to take such steps. This study also highlights the value of the assessment and implementation strategy process as a way for hospitals to engage with community needs.
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Affiliation(s)
- Cory E Cronin
- College of Health Sciences and Professions, Ohio University, Athens, OH, 45701, USA.
- Appalachian Institute to Advance Health Equity Science, Ohio University, Athens, OH, 45701, USA.
| | - Luke Kubacki
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA
| | - Lauren Donovan
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA
| | - Neeraj Puro
- College of Business, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Dakota Lavinder
- College of Arts and Sciences, Ohio University, Athens, OH, 45701, USA
| | - Kristin Schuller
- College of Health Professions, Towson University, 8000 York Rd, Towson, MD, 21252, USA
| | - Berkeley Franz
- Appalachian Institute to Advance Health Equity Science, Ohio University, Athens, OH, 45701, USA
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA
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Puro N, Cronin CE, Franz B, Singh S, Feyereisen S. Differential impact of hospital and community factors on breadth and depth of hospital population health partnerships. Health Serv Res 2024; 59 Suppl 1:e14238. [PMID: 37727122 PMCID: PMC10796292 DOI: 10.1111/1475-6773.14238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE The aim was to identify hospital and county characteristics associated with variation in breadth and depth of hospital partnerships with a broad range of organizations to improve population health. DATA SOURCES The American Hospital Association Annual Survey provided data on hospital partnerships to improve population health for the years 2017-2019. DESIGN The study adopts the dimensional publicness theory and social capital framework to examine hospital and county characteristics that facilitate hospital population health partnerships. The two dependent variables were number of local community organizations that hospitals partner with (breadth) and level of engagement with the partners (depth) to improve population health. The independent variables include three dimensions of publicness: Regulative, Normative and Cultural-cognitive measured by various hospital factors and presence of social capital present at county level. Covariates in the multivariate analysis included hospital factors such as bed-size and system membership. METHODS We used hierarchical linear regression models to assess various hospital and county factors associated with breadth and depth of hospital-community partnerships, adjusting for covariates. PRINCIPAL FINDINGS Nonprofit and public hospitals provided a greater breadth (coefficient, 1.61; SE, 0.11; p < 0.001 and coefficient, 0.95; SE, 0.14; p < 0.001) and depth (coefficient, 0.26, SE, 0.04; p < 0.001 & coefficient, 0.13; SE, 0.05; p < 0.05) of partnerships than their for-profit counterparts, partially supporting regulative dimension of publicness. At a county level, we found community social capital positively associated with breadth of partnerships (coefficient, 0.13; SE, 0.08; p < 0.001). CONCLUSIONS An environment that promotes collaboration between hospitals and organizations to improve population health may impact the health of the community by identifying health needs of the community, targeting social determinants of health, or by addressing patient social needs. However, findings suggest that publicness dimensions at an organizational level, which involves a culture of public value, maybe more important than county factors to achieve community building through partnerships.
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Affiliation(s)
- Neeraj Puro
- College of Business, Health Administration DepartmentFlorida Atlantic UniversityBoca RatonFloridaUSA
| | - Cory E. Cronin
- College of Health Sciences and ProfessionsOhio UniversityAthensOhioUSA
| | - Berkeley Franz
- Heritage College of Osteopathic MedicineOhio UniversityIrvineCaliforniaUSA
| | - Simone Singh
- Department of Health Management and PolicyUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Scott Feyereisen
- College of Business, Health Administration DepartmentFlorida Atlantic UniversityBoca RatonFloridaUSA
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Franz B, Dhanani LY, Hall OT, Brook DL, Fenstemaker C, Simon JE, Miller WC. Buprenorphine misinformation and willingness to treat patients with opioid use disorder among primary care-aligned health care professionals. Addict Sci Clin Pract 2024; 19:7. [PMID: 38243307 PMCID: PMC10797921 DOI: 10.1186/s13722-024-00436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Buprenorphine is a highly effective medication for opioid use disorder that is underused by health care professionals (HCPs). Medications for opioid use disorder (MOUD) misinformation may be an important barrier to buprenorphine access, but most implementation strategies have aimed to reduce negative attitudes towards patients with opioid use disorder (OUD) rather than misinformation specific to buprenorphine use. In this study, we assessed the degree to which HCPs endorsed misinformation related to buprenorphine, and whether this is associated with willingness to provide care to patients with OUD. METHODS In September-December of 2022, we surveyed HCPs practicing in Ohio (n = 409). Our primary outcomes included a previously validated 5-item measure of HCP willingness to treat patients with OUD, and three other measures of willingness. Our key independent variable was a study-developed 5-item measure of endorsement of misinformation related to buprenorphine, which assessed beliefs in buprenorphine's efficacy in managing withdrawal symptoms and reducing overdose deaths as well as beliefs about the role of buprenorphine in achieving remission. We computed descriptive and bivariable statistics and fit regression models predicting each outcome of interest. RESULTS On average, HCPs scored 2.34 out of 5.00 (SD = 0.80) on the composite measure of buprenorphine misinformation. 48.41% of participants endorsed at least one piece of misinformation. The most endorsed items were that buprenorphine is ineffective at reducing overdose deaths (M = 2.75, SD =0 .98), and that its use substitutes one drug for another (M = 2.41, SD = 1.25). HCP endorsement of buprenorphine misinformation significantly and negatively predicted willingness to work with patients with OUD (b = - 0.34; 95% CI - 0.46, - 0.21); intentions to increase time spent with this patient population (b = - 0.36; 95% CI - 5.86, - 1.28); receipt of an X-waiver (OR = 0.54, 95% CI 0.38, 0.77); and intention to get an X-waiver (OR: 0.56; 95% CI: 0.33-0.94). CONCLUSIONS Misinformation is common among HCPs and associated with lower willingness to treat patients with OUD. Implementation strategies to increase MOUD use among HCPs should specifically counter misinformation related to buprenorphine. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT05505227. Registered 17 August 2022, https://clinicaltrials.gov/ct2/show/NCT05505227.
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Affiliation(s)
- Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Department of Social Medicine, Ohio University Athens, Heritage Hall 1, Athens, OH, 45701-2979, USA.
- Appalachian Institute to Advance Health Equity Science, Athens, OH, USA.
| | - Lindsay Y Dhanani
- Rutgers University School of Management and Labor Relations, Piscataway, NJ, USA
| | - O Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel L Brook
- Ohio State University College of Public Health, Columbus, OH, USA
| | - Cheyenne Fenstemaker
- Ohio University Heritage College of Osteopathic Medicine, Department of Social Medicine, Ohio University Athens, Heritage Hall 1, Athens, OH, 45701-2979, USA
- Appalachian Institute to Advance Health Equity Science, Athens, OH, USA
| | - Janet E Simon
- Ohio University College of Health Sciences and Professions, Athens, OH, USA
| | - William C Miller
- Gillings School of Public Health , University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Franz B, Dhanani LY, Hall OT, Brook DL, Simon JE, Miller WC. Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US. Harm Reduct J 2023; 20:180. [PMID: 38129903 PMCID: PMC10740221 DOI: 10.1186/s12954-023-00918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Medications for opioid use disorder (OUD) are effective at preventing overdose and infectious disease but are vastly under-prescribed in the US. For decades, prescribers faced additional training and regulation to prescribe buprenorphine which stigmatized the medication and lessened support for a harm reduction approach to treating opioid use disorder. The Drug Enforcement Administration removed the X-waiver requirement for prescribing buprenorphine in late 2022, which removed stigma and lessened important barriers to prescribing but also left training at the discretion of individual organizations. Our study aimed to assess differences in knowledge, confidence, and stigma regarding buprenorphine between those who went through the X-waiver training and those who did not, among practicing primary care providers (PCPs). METHODS We assessed buprenorphine prescribing readiness among primary care aligned outpatient providers in Ohio, USA. Using survey data, we conducted bivariate and regression analyses predicting primary prescribing outcomes. Primary outcomes measured knowledge of and confidence in buprenorphine, as well as perceived adequacy of one's training. Secondary outcomes were attitudes toward patients with OUD, including bias toward OUD patients, stress when working with them, and empathy toward them. Participants (n = 403) included physicians, nurse practitioners, and physician assistants practicing in primary care aligned disciplines. RESULTS Survey data showed that PCPs who received X-waiver training were more likely to understand and have confidence in the mechanism of buprenorphine, and consider their training on treating OUD to be adequate. PCPs with an X-waiver showed more empathy, less negative bias, and experienced less stress when working with patients with OUD. CONCLUSION Removing restrictive policies for prescribing buprenorphine is an important step to expanding access and reducing the stigma associated with opioid use disorder treatment. Yet, our findings suggest that the training received alongside regulation may be important for improving prescribing confidence and reducing stigma. Strategies to increase buprenorphine prescribing are unlikely to be effective without also expanding access to prescribing support for primary care providers across the career course.
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Affiliation(s)
- Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Appalachian Institute to Advance Health Equity Science, Athens, OH, USA.
| | - Lindsay Y Dhanani
- Rutgers University School of Management and Labor Relations, Piscataway, NJ, USA
| | - O Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel L Brook
- Ohio State University College of Public Health, Columbus, OH, USA
| | - Janet E Simon
- Ohio University College of Health Sciences and Professions, Athens, OH, USA
| | - William C Miller
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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Dhanani LY, Miller WC, Hall OT, Brook DL, Simon JE, Go V, Franz B. Positive contact and empathy as predictors of primary care providers' willingness to prescribe medications for opioid use disorder. SSM Ment Health 2023; 4:100263. [PMID: 38558957 PMCID: PMC10979326 DOI: 10.1016/j.ssmmh.2023.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Introduction Patients with opioid use disorder (OUD) have a heightened need for quality health care, including access to evidence-based medications to reduce cravings and prevent overdose. However, primary care providers (PCPs) are reluctant to work with patients with OUD and implement medication prescribing into primary care practice. Previous studies have sought to identify potential ways to overcome these barriers, but often utilize interventions that facilitate both positive contact with as well as empathy for patients with OUD. In this study, we jointly assess positive contact and empathy to determine their unique impact on treatment attitudes and behaviors among PCPs, after controlling for other known predictors. Methods We surveyed 409 PCPs currently practicing in Ohio in 2022. Our primary dependent variables were willingness to work with patients with OUD, receipt of an X-waiver to prescribe buprenorphine, and interest in receiving an X-waiver. Our primary independent variables were positive contact and empathy toward patients with OUD. We computed bivariate correlations and multivariable linear regression (for continuous dependent variables) and logistic regression (for binary dependent variables) to understand the relationship between positive contact, empathy, and our outcome variables while accounting for other known predictors and relevant participant demographics. Results Positive contact was positively correlated with willingness to work with patients with OUD, receipt of the X-waiver, an interest in receiving the X-waiver, more frequent checking with patients about the need for naloxone, and higher odds of naloxone prescribing. These relationships held after accounting for PCP demographics, explicit bias toward patients with OUD, and overall levels of contact with patients with OUD. Empathy, conversely, was not a significant predictor of any treatment outcomes in the fully adjusted models. Conclusion Interventions and medical education programs aimed at improving treatment outcomes for patients with OUD should facilitate positive contact between PCPs and patients with OUD.
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Affiliation(s)
- Lindsay Y. Dhanani
- Rutgers University School of Management and Labor Relations, Piscataway, NJ, USA
| | | | - O. Trent Hall
- Ohio State University Wexner Medical Center, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Daniel L. Brook
- Ohio State University College of Public Health, Columbus, OH, USA
| | - Janet E. Simon
- Ohio University College of Health Sciences and Professions, Athens, OH, USA
| | - Vivian Go
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Appalachian Institute to Advance Health Equity Science, Athens, OH, USA
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Yeager VA, Burns A, Singh SR, Cronin CE, Franz B. Evaluation of Community Benefit Activities Among Nonprofit Hospitals, 2018-2021. J Public Health Manag Pract 2023; 29:E231-E236. [PMID: 37499100 DOI: 10.1097/phh.0000000000001794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE This study examined approaches that nonprofit hospitals use to evaluate community benefit activities in the Community Health Needs Assessment/Implementation Plan (CHNA/IP) process. DESIGN Content analysis of CHNAs/IPs completed between 2018 and 2021 from a 20% stratified random sample (n = 503) of US nonprofit hospitals. MAIN OUTCOME MEASURES A coding sheet was used to record details about the evaluation content reported by hospitals in their CHNAs/IPs. Evaluation was coded into 4 categories: (1) no mention of evaluation; (2) description of evaluation without reporting any measures; (3) reporting reach (number of people served) only; and (4) reporting social/health outcomes. For logistic regression analyses, categories 1 and 2 were grouped together into "no evaluation measures" and categories 3 and 4 were grouped into "evaluation measures" for binary comparison. Multinomial logistic regression was also used to individually examine categories 3 and 4 compared with no evaluation measures. RESULTS While a majority of nonprofit hospitals (71.4%, n = 359) mentioned evaluation in their CHNAs, almost half (49.7%, n = 250) did not report any evaluation measures. Among the 50.3% (n = 253) of hospitals that reported evaluation measures, 67.2% (n = 170) only reported reach. Fewer than 1 in 5 hospitals (16.5%, n = 83) reported social/health outcomes. Hospitals that hired a consultant (adjusted odds ratio [AOR] = 1.61; 95% confidence interval [CI], 1.08-2.43) and system members (AOR = 1.76; 95% CI, 1.12-2.75) had higher odds of reporting evaluation measures. Using hospitals that reported no measures as the base category, system members (AOR = 7.71; 95% CI, 2.97-20.00) also had significantly higher odds of reporting social/health outcomes, while rural locations had lower odds (AOR = 0.43; 95% CI, 0.20-0.94). CONCLUSIONS Although hospitals are required to evaluate the impact of actions taken to address the health needs identified in their CHNAs, few hospitals are reporting social/health outcomes of such activities. This represents a missed opportunity, as health/social outcomes could be used to inform the allocation of resources to maximize community benefits and the expansion of successful community initiatives.
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Affiliation(s)
- Valerie A Yeager
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana (Dr Yeager and Ms Burns); School of Public Health, University of Michigan, Ann Arbor, Michigan (Dr Singh); and College of Health Sciences and Professions (Dr Cronin) and Heritage College of Osteopathic Medicine (Dr Franz), Ohio University, Athens, Ohio
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Cronin CE, Singh S, Puro N, Franz B. Hospital Community Benefit Reporting: How Group Reporting Practices Limit Accountability. J Public Health Manag Pract 2023; 29:E237-E244. [PMID: 37350619 DOI: 10.1097/phh.0000000000001782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To identify the prevalence of group reporting of hospital community benefit efforts to the Internal Revenue Service (IRS) and understand hospital and community characteristics associated with this practice. DESIGN The study was based on data collected from publicly available community benefit reports from 2010 to 2019, as well as secondary data from the 2020 American Hospital Association (AHA) Annual Survey. The sample was drawn from the entire nonprofit US hospital population reporting community benefit activities. The analytic plan employed descriptive statistics and bivariate analysis. SETTING The United States. PARTICIPANTS All data are self-reported by US hospitals, either through the publication of community benefit reports (IRS Form 990 Schedule H) or a response to the AHA Annual Survey. MAIN OUTCOME MEASURES Analyzed variables include whether a hospital reported its community benefit expenditures individually or as a group member; community benefit spending as a percentage of hospital operating expenses; and whether the hospital was part of a multihospital system, with consideration of hospital and community characteristics. RESULTS Between 2010 and 2019, more than 40% of hospitals participated in group reporting, with most doing so consistently. System membership and hospital size were significantly and positively tied to group reporting, with state community benefit policy tied to the lower prevalence of group reporting. CONCLUSIONS The high prevalence of group reporting limits accountability to communities and restricts an accurate assessment of community benefit expenditures, counter to policy intentions. Stakeholders should consider what modifications to reporting rules could be made to promote transparency and to ensure that the effects of community benefit policies align with intentions.
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Affiliation(s)
- Cory E Cronin
- Department of Social and Public Health, Ohio University College of Health Sciences and Professions, Athens, Ohio (Dr Cronin); Appalachian Institute to Advance Health Equity Science, Ohio University, Athens, Ohio (Drs Cronin and Franz); Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan (Dr Singh); Management-Health Administration, Florida Atlantic University College of Business, Boca Raton, Florida (Dr Puro); and Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio (Dr Franz)
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Gutiérrez Á, Cronin CE, Franz B, Muniz-Terrera G. Alzheimer's Centers in US Hospitals: Enough to Adequately Address Dementia Care Nationwide? J Aging Health 2023:8982643231200691. [PMID: 37699204 DOI: 10.1177/08982643231200691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
OBJECTIVES To investigate the availability of Alzheimer's Centers (ACs) in US hospitals. METHODS Utilizing the American Hospital Association Annual Survey, Area Health Resource File, and US Census (n = 3251), we employed multivariable logistic regression to examine hospital, county, and regional predictors of AC availability. RESULTS Large hospitals (>399 beds) had approximately 14 times higher odds of having an AC than small hospitals (<50 beds; OR = 14.0; 95% CI = 6.44 - 30.46). Counties with a higher proportion of Latino residents, relative to non-Latino Whites, had lower odds of having an AC (OR = .05; 95% CI = .01 - .41). Northeastern (OR = 1.92; 95% CI = 1.15 - 3.22) and Midwestern (OR = 2.12; 95% CI = 1.34 - 3.37) hospitals had higher odds of having an AC than Southern hospitals. DISCUSSION To address dementia needs and disparities, investment in a national infrastructure is critical.
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Affiliation(s)
- Ángela Gutiérrez
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens OH, USA
| | - Cory E Cronin
- College of Health Sciences and Professions, Ohio University, Athens OH, USA
| | - Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens OH, USA
| | - Graciela Muniz-Terrera
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens OH, USA
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McNeill E, Cronin C, Puro N, Franz B, Silver D, Chang J. Variance of US Hospital Characteristics by Safety-Net Definition. JAMA Netw Open 2023; 6:e2332392. [PMID: 37672276 PMCID: PMC10483314 DOI: 10.1001/jamanetworkopen.2023.32392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
This cross-sectional study examines whether characteristics of hospitals differ across 5 frequently used safety-net hospital definitions using 2020 data.
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Affiliation(s)
- Elizabeth McNeill
- New York University School of Global Public Health, New York, New York
| | - Cory Cronin
- Ohio University, Athens, Ohio
- Appalachian Institute to Advance Health Equity Science (ADVANCE), Athens, Ohio
| | - Neeraj Puro
- Florida Atlantic University, Boca Raton, Florida
| | - Berkeley Franz
- Appalachian Institute to Advance Health Equity Science (ADVANCE), Athens, Ohio
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Diana Silver
- New York University School of Global Public Health, New York, New York
| | - Ji Chang
- New York University School of Global Public Health, New York, New York
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Lemont B, Puro N, Franz B, Cronin CE. Efforts by critical access hospitals to increase health equity through greater engagement with social determinants of health. J Rural Health 2023; 39:728-736. [PMID: 37296509 DOI: 10.1111/jrh.12771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/21/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Greater health care engagement with social determinants of health (SDOH) is critical to improving health equity. However, no national studies have compared programs to address patient social needs among critical access hospitals (CAHs), which are lifelines for rural communities. CAHs generally have fewer resources and receive governmental support to maintain operations. This study considers the extent to which CAHs engage in community health improvement, particularly upstream SDOH, and whether organizational or community factors predict involvement. METHODS Using descriptive statistics and Poisson regression, we compared 3 types of programs (screening, in-house strategies, and external partnerships) to address the patient social needs between CAHs and non-CAHs, independent of key organizational, county, and state factors. FINDINGS CAHs were less likely than non-CAHs to have programs to screen patients for social needs, address unmet social needs of patients, and enact community partnerships to address SDOH. When we stratified hospitals according to whether they endorsed an equity-focused approach as an organization, CAHs matched their non-CAH counterparts on all 3 types of programs. CONCLUSIONS CAHs lag relative to their urban and non-CAH counterparts in their ability to address nonmedical needs of their patients and broader communities. While the Flex Program has shown success in offering technical assistance to rural hospitals, this program has mainly focused on traditional hospital services to address patients' acute health care needs. Our findings suggest that organizational and policy efforts surrounding health equity could bring CAHs in line with other hospitals in terms of their ability to support rural population health.
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Affiliation(s)
- Bethany Lemont
- Economics Department, Ohio University College of Arts & Sciences; Appalachian Institute to Advance Health Equity Science, Athens, Ohio, USA
| | - Neeraj Puro
- Management-Health Administration, Florida Atlantic University College of Business, Boca Raton, Florida, USA
| | - Berkeley Franz
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine; Appalachian Institute to Advance Health Equity Science, Athens, Ohio, USA
| | - Cory E Cronin
- Department of Social and Public Health, Ohio University College of Health Sciences and Professions; Appalachian Institute to Advance Health Equity Science, Athens, Ohio, USA
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Chang JE, Franz B, Pagán JA, Lindenfeld Z, Cronin CE. Substance Use Disorder Program Availability in Safety-Net and Non-Safety-Net Hospitals in the US. JAMA Netw Open 2023; 6:e2331243. [PMID: 37639270 PMCID: PMC10463097 DOI: 10.1001/jamanetworkopen.2023.31243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023] Open
Abstract
Importance Safety-net hospitals (SNHs) are ideal sites to deliver addiction treatment to patients with substance use disorders (SUDs), but the availability of these services within SNHs nationwide remains unknown. Objective To examine differences in the delivery of different SUD programs in SNHs vs non-SNHs across the US and to determine whether these differences are increased in certain types of SNHs depending on ownership. Design, Setting, and Participants This cross-sectional analysis used data from the 2021 American Hospital Association Annual Survey of Hospitals to examine the associations of safety-net status and ownership with the availability of SUD services at acute care hospitals in the US. Data analysis was performed from January to March 2022. Main Outcomes and Measures This study used 2 survey questions from the American Hospital Association survey to determine the delivery of 5 hospital-based SUD services: screening, consultation, inpatient treatment services, outpatient treatment services, and medications for opioid use disorder (MOUD). Results A total of 2846 hospitals were included: 409 were SNHs and 2437 were non-SNHs. The lowest proportion of hospitals reported offering inpatient treatment services (791 hospitals [27%]), followed by MOUD (1055 hospitals [37%]), and outpatient treatment services (1087 hospitals [38%]). The majority of hospitals reported offering consultation (1704 hospitals [60%]) and screening (2240 hospitals [79%]). In multivariable models, SNHs were significantly less likely to offer SUD services across all 5 categories of services (screening odds ratio [OR], 0.62 [95% CI, 0.48-0.76]; consultation OR, 0.62 [95% CI, 0.47-0.83]; inpatient services OR, 0.73 [95% CI, 0.55-0.97]; outpatient services OR, 0.76 [95% CI, 0.59-0.99]; MOUD OR, 0.6 [95% CI, 0.46-0.78]). With the exception of MOUD, public or for-profit SNHs did not differ significantly from their non-SNH counterparts. However, nonprofit SNHs were significantly less likely to offer all 5 SUD services compared with their non-SNH counterparts (screening OR, 0.52 [95% CI, 0.41-0.66]; consultation OR, 0.56 [95% CI, 0.44-0.73]; inpatient services OR, 0.45 [95% CI, 0.33-0.61]; outpatient services OR, 0.58 [95% CI, 0.44-0.76]; MOUD OR, 0.61 [95% CI, 0.46-0.79]). Conclusions and Relevance In this cross-sectional study of SNHs and non-SNHs, SNHs had significantly lower odds of offering the full range of SUD services. These findings add to a growing body of research suggesting that SNHs may face additional barriers to offering SUD programs. Further research is needed to understand these barriers and to identify strategies that support the adoption of evidence-based SUD programs in SNH settings.
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Affiliation(s)
- Ji E. Chang
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Berkeley Franz
- Heritage College of Osteopathic Medicine, Ohio University, Athens
| | - José A. Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Zoe Lindenfeld
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Cory E. Cronin
- College of Health Sciences and Professions, Ohio University, Athens
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Chang JE, Cronin CE, Pagán JA, Simon J, Lindenfeld Z, Franz B. Trends in the Prioritization and Implementation of Substance Use Programs by Nonprofit Hospitals: 2015-2021. J Addict Med 2023; 17:e217-e223. [PMID: 37579091 DOI: 10.1097/adm.0000000000001128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Hospitalizations are an important opportunity to address substance use through inpatient services, outpatient care, and community partnerships, yet the extent to which nonprofit hospitals prioritize such services across time remains unknown. The objective of this study is to examine trends in nonprofit hospitals' prioritization and implementation of substance use disorder (SUD) programs. METHODS We assessed trends in hospital prioritization of substance use as a top five community need and hospital implementation of SUD programing at nonprofit hospitals between 2015 and 2021 using two waves (wave 1: 2015-2018; wave 2: 2019-2021) by examining hospital community benefit reports. We utilized t or χ 2 tests to understand whether there were significant differences in the prioritization and implementation of SUD programs across waves. We used multilevel logistic regression to evaluate the relation between prioritization and implementation of SUD programs, hospital and community characteristics, and wave. RESULTS Hospitals were less likely to have prioritized SUD but more likely to have implemented SUD programs in the most recent 3 years compared, even after adjusting for the local overdose rate and hospital- and community-level variables. Although most hospitals consistently prioritized and implemented SUD programs during the 2015-2021 period, a 11% removed and 15% never adopted SUD programs at all, despite an overall increase in overdose rates. CONCLUSIONS Our study identified gaps in hospital SUD infrastructure during a time of elevated need. Failing to address this gap reflects missed opportunities to engage vulnerable populations, provide linkages to treatment, and prevent complications of substance use.
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Affiliation(s)
- Ji Eun Chang
- From the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY (JEC, JAP, ZL); College of Health Sciences and Professions, Ohio University, Athens, OH (CC); Heritage College of Osteopathic Medicine, Ohio University, Athens, OH (JS, BF); and Ohio University Appalachian Institute to Advance Health Equity Science (BF, CEC)
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Cronin CE, Franz B. The public availability of hospital CHNA reports: limitations and potential to study hospital investments in the next phase of public health. Front Health Serv 2023; 3:1165928. [PMID: 37363732 PMCID: PMC10285662 DOI: 10.3389/frhs.2023.1165928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023]
Abstract
Nonprofit hospitals have been required to complete and make publicly available their community benefit reports for more than a decade, a sign of changing expectations for private health care organizations to explicitly collaborate with public health departments to improve community health. Despite these important changes to practice and policy, no governmental agency provides statistics regarding compliance with this process. To better understand the nature and usefulness of the data provided through these processes, we led a research team that collected and coded Community Health Needs Assessment (CHNA) and Implementation Strategy (IS) Reports for a nationally representative sample of hospitals between 2018 and 2022. We utilized descriptive statistics to understand the frequency of noncompliance; t-tests and chi-square tests were employed to identify characteristics associated with incomplete documents. Approximately 95% of hospitals provided a public CHNA, and approximately 86% made their IS available. The extent of compliance with the CHNA/IS mandate indicates that these documents, paired with existing public health and policy data, offer considerable potential for understanding the investments nonprofit hospitals make to improve health outcomes and health equity in the communities they serve.
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Affiliation(s)
- Cory E. Cronin
- College of Health Sciences and Professions, Ohio University, Athens, OH, United States
- Appalachian Institute to Advance Health Equity Science, College of Health Sciences and Professions, Ohio University, Athens, OH, United States
| | - Berkeley Franz
- Appalachian Institute to Advance Health Equity Science, College of Health Sciences and Professions, Ohio University, Athens, OH, United States
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United States
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Lindenfeld Z, Franz B, Cronin C, Chang JE. Hospital adoption of harm reduction and risk education strategies to address substance use disorders. Am J Drug Alcohol Abuse 2023; 49:206-215. [PMID: 36877147 DOI: 10.1080/00952990.2023.2169832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Background: Hospitals are well-positioned to integrate harm reduction into their workflow. However, the extent to which hospitals across the United States are adopting these strategies remains unknown.Objectives: To assess what factors are associated with hospital adoption of harm reduction/risk education strategies, and trends of adoption across time.Methods: We constructed a dataset marking implementation of harm reduction/risk education strategies for a 20% random sample of nonprofit hospitals in the U.S (n = 489) using 2019-2021 community health needs assessments (CHNAs) and implementation strategies obtained from hospital websites. We used two-level mixed effects logistic regression to test the association between adoption of these activities and organizational and community-level variables. We also compared the proportion of hospitals that adopted these strategies in the 2019-2021 CHNAs to an earlier cohort (2015-2018.)Results: In the 2019-2021 CHNAs, 44.7% (n = 219) of hospitals implemented harm reduction/risk education programs, compared with 34.1% (n = 156) in the 2015-2018 cycle. In our multivariate model, hospitals that implemented harm reduction/risk education programs had higher odds of having adopted three or more additional substance use disorder (SUD) programs (OR: 10.5: 95% CI: 5.35-20.62), writing the CHNA with a community organization (OR: 2.14; 95% CI: 1.15-3.97), and prioritizing SUD as a top three need in the CHNA (OR: 2.63; 95% CI: 1.54-4.47.)Conclusions: Our results suggest that hospitals with an existing SUD infrastructure and with connections to community are more likely to implement harm reduction/risk education programs. Policymakers should consider these findings when developing strategies to encourage hospital implementation of harm reduction activities.
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Affiliation(s)
- Zoe Lindenfeld
- Department of Public Health Policy and Management, School of Global Public Health, New York University, Broadway, NY, USA
| | - Berkeley Franz
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Cory Cronin
- College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Ji Eun Chang
- Department of Public Health Policy and Management, School of Global Public Health, New York University, Broadway, NY, USA
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Choyke KL, Franz B, Rodriguez V, Cronin CE. For-profit hospitals could play a distinctive role as anchor institutions. J Eval Clin Pract 2023; 29:108-116. [PMID: 35854668 PMCID: PMC10084393 DOI: 10.1111/jep.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE Hospitals have a longstanding presence in United States communities and contribute to economic development and community well-being through widespread employment, purchasing and direct community engagement. Most of the data on anchor institutions to date, however, has focused on nonprofit organisations, especially nonprofit hospitals, colleges and universities. The aim of this study is to better understand if for-profit hospitals engage in explicit anchor activities, and whether these organisations adopt unique strategies in carrying out this study. METHODS We used an inductive, qualitative approach to understand how for-profit hospitals perceive their anchoring efforts as distinct as compared to nonprofits. We conducted in-depth interviews with 23 hospital leaders, researchers and members of advocacy organisations, representing 11 different hospital organisations and 10 communities; and used thematic analysis to generate study findings. RESULTS For-profit hospitals do see at least three primary differences that render them distinctive in their efforts to anchor themselves within their communities-namely, barriers that for-profits encounter that nonprofits may not; their emphasis on strategic and synergistic practices; and their status as hospitals that also support their communities economically as tax-paying entities. CONCLUSION With a better understanding of their unique contributions as for-profit organisations, policymakers can identify ways to leverage these hospitals to support their communities through outreach and engagement.
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Affiliation(s)
- Kelly Lynn Choyke
- Heritage College of Osteopathic Medicine, Social Medicine, Ohio University, Athens, Ohio, USA
| | - Berkeley Franz
- College of Health Science and Professions, Social and Public Health, Ohio University, Athens, Ohio, USA
| | - Vanessa Rodriguez
- College of Health Science and Professions, Social and Public Health, Ohio University, Athens, Ohio, USA
| | - Cory E Cronin
- The Appalachian Institute to Advance Health Equity Science, Ohio University, Athens, USA
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Chang JE, Cronin CE, Lindenfeld Z, Pagán JA, Franz B. Association of Medicaid expansion and 1115 waivers for substance use disorders with hospital provision of opioid use disorder services: a cross sectional study. BMC Health Serv Res 2023; 23:87. [PMID: 36703146 PMCID: PMC9877490 DOI: 10.1186/s12913-023-09035-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Opioid-related hospitalizations have risen dramatically, placing hospitals at the frontlines of the opioid epidemic. Medicaid expansion and 1115 waivers for substance use disorders (SUDs) are two key policies aimed at expanding access to care, including opioid use disorder (OUD) services. Yet, little is known about the relationship between these policies and the availability of hospital based OUD programs. The aim of this study is to determine whether state Medicaid expansion and adoption of 1115 waivers for SUDs are associated with hospital provision of OUD programs. METHODS We conducted a cross-sectional study of a random sample of hospitals (n = 457) from the American Hospital Association's 2015 American Hospital Directory, compiled with the most recent publicly available community health needs assessment (2015-2018). RESULTS Controlling for hospital characteristics, overdose burden, and socio-demographic characteristics, both Medicaid policies were associated with hospital adoption of several OUD programs. Hospitals in Medicaid expansion states had significantly higher odds of implementing any program related to SUDs (OR: 1.740; 95% CI: 1.032-2.934) as well as some specific activities such as programs for OUD treatment (OR: 1.955; 95% CI: 1.245-3.070) and efforts to address social determinants of health (OR: 6.787; 95% CI: 1.308-35.20). State 1115 waivers for SUDs were not significantly associated with any hospital-based SUD activities. CONCLUSIONS Medicaid expansion was associated with several hospital programs for addressing OUD. The differential availability of hospital-based OUD programs may indicate an added layer of disadvantage for low-income patients with SUD living in non-expansion states.
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Affiliation(s)
- Ji Eun Chang
- grid.137628.90000 0004 1936 8753Department of Public Health Policy and Management, School of Global Public Health, New York University, 726 Broadway, New York, NY 10012 USA
| | - Cory E. Cronin
- grid.20627.310000 0001 0668 7841College of Health Sciences and Professions, Ohio University, 1 Ohio University, Athens, OH 45701 USA
| | - Zoe Lindenfeld
- grid.137628.90000 0004 1936 8753Department of Public Health Policy and Management, School of Global Public Health, New York University, 726 Broadway, New York, NY 10012 USA
| | - José A. Pagán
- grid.137628.90000 0004 1936 8753Department of Public Health Policy and Management, School of Global Public Health, New York University, 726 Broadway, New York, NY 10012 USA
| | - Berkeley Franz
- grid.20627.310000 0001 0668 7841Heritage College of Osteopathic Medicine, Ohio University, 1 Ohio University, Athens, OH 45701 USA
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Singh SR, Cronin CE, Conley C, Lenhart M, Franz B. Equity as a Guiding Theme in Hospitals' Community Health Needs Assessments. Am J Prev Med 2023; 64:26-32. [PMID: 36127195 DOI: 10.1016/j.amepre.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION This study explores the relationship between nonprofit hospitals' use of equity as a guiding theme in the development of their community health needs assessments and the level of alignment between the health needs identified in the community health needs assessment and those addressed in hospitals' implementation strategy. METHODS Using data from a nationally representative data set of 485 nonprofit hospital community health needs assessments for the years 2018-2021, this study employed a multivariate logistic regression model to examine the association between hospitals' use of equity as a guiding theme in the community health needs assessment and binary indicators of alignment for 6 common community health needs: access to care, chronic illness, obesity, mental health, substance use, and social determinants of health. RESULTS Hospitals using equity as a guiding theme in their community health needs assessment reported significantly greater alignment for 3 needs: access to care (OR=3.40), substance use (OR=2.75), and social determinants of health (OR=3.60). CONCLUSIONS Using equity as a guiding theme in the needs assessment process can help to align hospitals' community health initiatives with the most pressing health needs, thus contributing to public health improvement.
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Affiliation(s)
- Simone R Singh
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Cory E Cronin
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, Ohio
| | - Cherie Conley
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Margaret Lenhart
- Department of Economics, University of Notre Dame, Notre Dame, Indiana
| | - Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio
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Hughes AS, Gutierrez A, Flint J, Franz B. Availability of Evidence-Based Diabetes Programs in U.S. Children's Hospitals. J Prim Care Community Health 2023; 14:21501319231189952. [PMID: 37522592 PMCID: PMC10392184 DOI: 10.1177/21501319231189952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
Diabetes affects Americans across the lifespan requiring individual and community-level interventions for prevention and management. Nonprofit hospitals are required to address community health needs under current tax law. The study objective was to assess what strategies children's hospitals implemented in prevention and care of diabetes and determine how many hospitals used evidence-based strategies. We identified the most recent Children's Hospital Needs Assessments and implementation strategies for each hospital. Data were thematically coded. Twenty-nine of the 233 U.S. children's hospitals addressed diabetes in their community benefit investments. Of the 130 hospital programs, 48 (37%) aligned with the DSMES framework. Programs focused on prevention (32%), healthy eating (18%), education (15%), physical activity (12%), quality improvement (11%), and self-management (5%). Most children's hospital interventions (85%) did not state a focus on reducing health disparities and none addressed problem solving or diabetes technology. Minimal hospitals are using evidence-based programming for diabetes management and are not targeting health disparities which undercuts their efforts. Hospitals are not adopting structural evidence-based approaches, missing key opportunities to implement strategies shown to reduce diabetes prevalence and lower A1c. This study suggests that children's hospitals need improvement in their diabetes programming to better serve their communities.
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Affiliation(s)
- Allyson S. Hughes
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Angela Gutierrez
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Julia Flint
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
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Franz B, Cronin CE, Yeager VA, Burns A, Singh SR. Overview of the Most Commonly Identified Public Health Needs and Strategies in a Nationally Representative Sample of Nonprofit Hospitals. Med Care Res Rev 2022; 80:342-351. [PMID: 36377207 DOI: 10.1177/10775587221135365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nonprofit hospitals have been required to conduct Community Health Needs Assessments and develop implementation strategies for almost a decade, yet little is known about this process on the national level. Using a nationally representative dataset of 2019 to 2021 nonprofit hospital community benefit reports, we assessed patterns in hospital identification of community health needs and investments in corresponding programs. The five most common needs identified by hospitals were mental health (identified by 87% of hospitals), substance use (76%), access (73%), social determinants of health (69%), and chronic disease (67%). The five most common needs addressed were: mental health (87%), access (81%), substance use (77%), chronic disease (72%), and obesity (71%). Institutional and community-level factors were associated with whether hospitals identified and addressed health needs. Hospitals often addressed needs that they did not identify, particularly related to the provision of medical services—which has important implications for population health improvement.
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Dhanani LY, Franz B, Pham CT. Experiencing, anticipating, and witnessing discrimination during the COVID-19 pandemic: Implications for health and wellbeing among Asian Americans. Front Public Health 2022; 10:949403. [PMID: 36311624 PMCID: PMC9608515 DOI: 10.3389/fpubh.2022.949403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/20/2022] [Indexed: 01/21/2023] Open
Abstract
The onset of the COVID-19 pandemic spurred increased racial animus toward Asians and Asian Americans (A/AA) who have since been contending with increased racism and violence. While some of the harm associated with this increased prejudice may derive from personally experienced discrimination, the COVID-19 pandemic has also been marked by an increase in vicarious exposure to discrimination as well as increased anticipation of discrimination, both of which may be taxing for the mental and physical health of A/AA. The goal of this study, accordingly, was to examine the effects of personal experiences of discrimination, vicarious exposure to discrimination, and anticipated discrimination on depressive symptoms, physical health symptoms, sleep quality, and sleep disturbances among A/AA. Results from our two-wave field survey demonstrated that experiencing and anticipating discrimination were associated with mental and physical health symptoms as well as sleep disturbances. Further, personal experiences of discrimination interacted with vicarious discrimination to determine physical health symptoms such that greater vicarious exposure weakened the relationship between experienced discrimination and physical health symptoms. These findings demonstrate the need to mobilize resources to combat the multipronged, negative implications of the recent rise in anti-Asian prejudice during the COVID-19 pandemic.
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Affiliation(s)
- Lindsay Y. Dhanani
- School of Management and Labor Relations, Rutgers University, Piscataway, NJ, United States,*Correspondence: Lindsay Y. Dhanani
| | - Berkeley Franz
- Heritage College of Osteopathic Medicine, Appalachian Institute to Advance Health Equity Science, Ohio University, Athens, OH, United States
| | - Carolyn T. Pham
- Psychology Department, DePaul University, Chicago, IL, United States
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Puro N, Cronin CE, Franz B, Singh S. Exploring the Role of Community Social Capital in Not-for-profit Hospitals’ Decision to Engage Community Partners in the Community Health Needs Assessment Process. Med Care Res Rev 2022; 80:333-341. [PMID: 36121004 DOI: 10.1177/10775587221124238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Not-for-profit hospitals (NFPs) frequently partner with community organizations to conduct internal revenue service-mandated community health needs assessment (CHNA), yet little is known about the number of partnerships that hospitals enter into for this purpose. This article uses “American Hospital Associations’ 2020 Annual Survey” data to examine hospital-community partnerships around the CHNA and the role that community social capital defined as, “the networks that cross various professional, political and social boundaries to reflect community level trust needed to pursue shared objectives” plays in hospitals’ choices to partner with community organizations for the CHNA. After controlling for a set of hospital, community, and state characteristics, we found that hospitals present in communities with higher social capital were likely to partner with more community organizations to conduct CHNA. Greater social capital may thus promote community health by facilitating the partnerships NFPs develop with community organizations to conduct the CHNA.
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Affiliation(s)
- Neeraj Puro
- Florida Atlantic University, Boca Raton, USA
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Dhanani LY, Franz B. An experimental study of the effects of messaging strategies on vaccine acceptance and hesitancy among Black Americans. Prev Med Rep 2022; 27:101792. [PMID: 35433238 PMCID: PMC9006422 DOI: 10.1016/j.pmedr.2022.101792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 12/05/2022] Open
Abstract
Acknowledging past medical harm led to more positive COVID-19 vaccine attitudes. Presenting general information about the vaccine did not improve vaccine attitudes. Tailored messaging strategies showed no backfire effects in other racial groups.
Black Americans have been disproportionately affected by COVID-19 but have comparatively low vaccination rates, creating a need for vaccine messaging strategies that are tailored to this population. We conducted an experimental study to examine the effects of three messaging strategies on Black Americans’ reported willingness to receive the vaccine and vaccine hesitancy. We also recruited White and Hispanic Americans to assess any potential backfire effects of the tailored strategies for non-Black participants. A total of 739 participants completed the study. Results from 4x2 ANCOVAs indicate that, among Black participants, messaging that acknowledged past unethical treatment of Black Americans in medical research and emphasized current safeguards to prevent medical mistreatment was associated with significantly less vaccine hesitancy than the control condition. The same effects were not observed for messaging strategies that provided general safety information about the vaccine or that emphasized the role of the vaccine in reducing racial inequities. There were no significant differences across conditions for participants of other races. Results demonstrate that public health messages tailored to address specific vaccine concerns may aid future vaccination campaigns.
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Chang JE, Franz B, Cronin CE, Lindenfeld Z, Lai AY, Pagán JA. Racial/ethnic disparities in the availability of hospital based opioid use disorder treatment. J Subst Abuse Treat 2022; 138:108719. [DOI: 10.1016/j.jsat.2022.108719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 12/23/2022]
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Franz B, Parker B, Milner A, Braddock JH. The Relationship between Systemic Racism, Residential Segregation, and Racial/Ethnic Disparities in COVID-19 Deaths in the United States. Ethn Dis 2022; 32:31-38. [PMID: 35106042 PMCID: PMC8785866 DOI: 10.18865/ed.32.1.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2023] Open
Abstract
Introduction Although Black Americans are not substantially more likely to be diagnosed with COVID-19, hospitalization rates and death rates are considerably higher than for White Americans. The aim of this study was to assess the relationship between systemic racism generally, and residential segregation in particular, and racial/ethnic disparities in deaths due to COVID-19. Methods To assess racial disparities in COVID-19 and systemic racism in US states, we calculated descriptive statistics and bivariate Pearson correlations. Using data on deaths through December 2020, we developed a weighted logistic mixed model to assess whether state-level systemic racism generally and residential segregation, in particular, predicted the probability of COVID-19 deaths among Americans, considering key sociodemographic factors. Results Residential segregation is a stronger predictor of COVID-19 deaths among Black Americans, as compared to systemic racism more generally. Looking at the interaction between residential segregation and COVID-19 death rates by race, residential segregation is associated with negative outcomes for Black and White Americans, but disproportionately impacts Black state residents (P<.001), who have 2.14 times higher odds of dying from COVID-19 when residential segregation is increased. Conclusion To understand and address disparities in infectious disease, researchers and public health practitioners should acknowledge how different forms of systemic racism shape health outcomes in the United States. More attention should be given to the mechanisms by which infectious disease pandemics exacerbate health disparities in areas of high residential segregation and should inform more targeted health policies. Such policy changes stand to make all American communities more resilient in the face of new and emerging infectious diseases.
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Affiliation(s)
- Berkeley Franz
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Ben Parker
- Department of Mathematics, Brunel University London, Uxbridge, UK
| | - Adrienne Milner
- Department of Health Sciences, Brunel University London, Uxbridge, UK
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Abstract
BACKGROUND Physicians are on the front lines of the U.S. opioid epidemic, providing care in multiple treatment settings. Very little is known, however, about whether this experience has contributed to physician burnout. This information is critical for guiding efforts to expand the relatively low level of training on opioid misuse currently available in medical education. METHODS We surveyed 408 board-certified physicians practicing in Ohio about their experiences working with patients who misuse opioids. We also collected quantitative measures of physicians' burnout and their level of contact with this patient population. We coded and analyzed open-ended responses and calculated a partial correlation between contact and burnout, controlling for relevant factors. RESULTS Physicians experienced three primary barriers when working with patients who misuse opioids: inadequate knowledge and training, limited external resources and partnerships in their communities, and an incomplete context for understanding problematic patient behaviors. 70% of physicians experienced negative emotions when working with this patient population and 19% mentioned experiencing burnout specifically. Contact with patients who misuse opioids was significantly and positively associated with burnout scores. CONCLUSIONS Our findings underscore the need for medical educators to take a proactive approach to equipping physicians with the knowledge, skills, and resources needed to effectively work with patients who misuse opioids.
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Affiliation(s)
| | - Emily L Harris
- OMS-III, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Jordan Mirto
- OMS-III, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Berkeley Franz
- Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
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Franz B, Cronin CE, Rodriguez V, Choyke K, Simon JE, Hall MT. For-profit hospitals as anchor institutions in the United States: a study of organizational stability. BMC Health Serv Res 2021; 21:1326. [PMID: 34895229 PMCID: PMC8665525 DOI: 10.1186/s12913-021-07307-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Anchor institutions, by definition, have a long-term presence within their local communities, but it is uncertain as to whether for-profit hospitals meet this definition; most research on anchor institutions to date has been limited to nonprofit organizations such as hospitals and universities. Accordingly, this study aims to determine whether for-profit hospitals are stable enough to fulfill the role of anchor institutions through a long-term presence in communities which may help to stabilize local economies. Methods This longitudinal study analyzes national, secondary data between 2008 and 2017 compiled from the Dartmouth Atlas of Health Care, the American Hospital Association Annual Survey, and County Health Rankings. We use descriptive statistics to calculate the number of closures and mergers of hospitals of different ownership type, as well as staffing levels. Using logistic regression, we also assessed whether for-profit hospitals had higher odds of closing and merging, controlling for both organization and community factors. Results We found for-profit hospitals to be less stable than their public and nonprofit hospital counterparts, experiencing disproportionately more closures and mergers over time, with a multivariable analysis indicating a statistically significant difference. Furthermore, for-profit hospitals have fewer full-time employees relative to their size than hospitals of other ownership types, as well as lower total payroll expenditures. Conclusions Study findings suggest that for-profit hospitals operate more efficiently in terms of expenses, but this also may translate into a lower level of economic contributions to the surrounding community through employment and purchasing initiatives. For-profit hospitals may also not have the stability required to serve as long-standing anchor institutions. Future studies should consider whether for-profit hospitals make other types of community investments to offset these deficits and whether policy changes can be employed to encourage anchor activities from local businesses such as hospitals.
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Affiliation(s)
- Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Irvine Hall 210, Athens, OH, 45701, USA.
| | - Cory E Cronin
- Department of Social and Public Health, Ohio University, Grover Center W359, Athens, OH, 45701, USA
| | - Vanessa Rodriguez
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Irvine Hall 210, Athens, OH, 45701, USA
| | - Kelly Choyke
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Irvine Hall 210, Athens, OH, 45701, USA
| | - Janet E Simon
- College of Applied Health Sciences and Wellness, Ohio Unitversity, Ohio Musculoskeletal and Neurological Design, Grover Center E150, Athens, OH, 45701, USA
| | - Maxwell T Hall
- Department of Social and Public Health, Ohio University, Grover Center W359, Athens, OH, 45701, USA
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Dhanani LY, Franz B, Hall TK. Revisiting the relationship between contact and physician attitudes toward patients with opioid use disorder. Addict Behav Rep 2021; 14:100372. [PMID: 34938833 PMCID: PMC8664778 DOI: 10.1016/j.abrep.2021.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Prior research suggests that some physicians hold negative attitudes toward patients who misuse opioids and that this serves as a barrier which limits the availability and effectiveness of health care services. Interventions which improve physicians' attitudes have thus garnered attention, many of which have focused on increasing contact between physicians and patients who misuse opioids. However, drawing on recent literature on intergroup contact, the current paper argues that contact may not have uniformly positive effects on prejudice. METHODS We surveyed 408 board-certified physicians in the state of Ohio where many opioid overdose deaths have been concentrated. We used regression to test for interactions between contact and three focal variables, bias, burnout, and stress, on physician willingness to work with patients who misuse opioids. RESULTS The negative relationships between bias, physician burnout, and stress induced by working with patients who misuse opioids and physicians' willingness to work with this patient population are each exacerbated when contact with patients who misuse opioids is high. CONCLUSIONS Although intervention studies have shown promise for the role that increased contact may have in reducing stigma toward patients who misuse opioids, these interventions may not be appropriate for physicians who are experiencing strain or who hold preexisting negative attitudes toward this patient population. Future interventions may need to target bias, burnout, and stress, in addition to facilitating contact, to increase physician willingness to work with these patients.
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Affiliation(s)
- Lindsay Y. Dhanani
- Department of Psychology, Ohio University, 22 Richland Avenue, Athens, OH 45701, United States
| | - Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Grosvenor 311, Athens, OH 45701, United States
| | - Taylor K. Hall
- Department of Psychology, Ohio University, 22 Richland Avenue, Athens, OH 45701, United States
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Franz B, Cronin CE, Singh S. Are Nonprofit Hospitals Addressing the Most Critical Community Health Needs That They Identify in Their Community Health Needs Assessments? J Public Health Manag Pract 2021; 27:80-87. [PMID: 31415264 DOI: 10.1097/phh.0000000000001034] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Virtually all nonprofit hospitals are in compliance with the Affordable Care Act's new Community Health Needs Assessments requirements. OBJECTIVE To assess what needs have emerged in the Community Health Needs Assessments hospitals complete nationally, the degree to which identified needs reflect the most pressing community health issues, and the extent to which hospitals address identified needs. DESIGN Using both bivariate and logistic regressions, we analyzed the Community Health Needs Assessments and implementation strategies of nonprofit hospitals to determine whether identified needs overlapped with county health-ranking indicators of need and whether institutional or community-level factors predicted hospital willingness to address identified needs. PARTICIPANTS We included a 20% random sample of US nonprofit hospitals (n = 496). MAIN OUTCOME MEASURES Our main outcome measures were whether nonprofit hospitals addressed each of the most common needs. RESULTS Mental health, access to care, obesity, substance abuse, diabetes, cancer, and the social determinants of health were the most commonly identified needs across the sample. The rate at which hospitals chose to address each of these needs in their implementation strategies, however, varied considerably, ranging from 56% (cancer) to 85% (obesity). We found that several institutional and community characteristics predicted hospital willingness to address each need; whether the community ranked a need as number 1 was a better predictor of hospital investment than the severity of the need, as measured by county health-rankings data. CONCLUSIONS These findings may help inform local, state, and federal policy makers as they consider interventions aimed at encouraging hospitals to invest in improving the health of their communities.
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Affiliation(s)
- Berkeley Franz
- Departments of Social Medicine, Heritage College of Osteopathic Medicine (Dr Franz) and Social and Public Health, College of Health Sciences and Professions (Dr Cronin), Ohio University, Athens, Ohio; and School of Public Health, University of Michigan, Ann Arbor, Michigan (Dr Singh)
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Abstract
OBJECTIVE Effective treatments for opioid use disorder exist, but rural areas of the United States have a shortage of services offering such treatments. Physician bias toward patients with opioid use disorder can also limit care access, but no studies have assessed whether physician bias is a more acute barrier in rural compared with urban communities. METHODS In total, 408 board-certified physicians in Ohio, a state with a high rate of opioid overdoses, completed an online survey examining perspectives on clinical care for patients who misuse opioids. Respondents with missing county-level data were excluded, leaving a total sample of 274. The authors used t tests to determine rural-urban differences in bias, key predictors of bias, and availability of opioid services. Multivariable regression modeling was used to estimate rural-urban differences in bias independent of key bias predictors. RESULTS Physicians in rural areas (N=37) reported higher levels of bias toward patients with opioid use disorder than did their urban counterparts (N=237). This difference remained statistically significant even after accounting for known bias predictors and physician specialty. Physicians specializing in addiction medicine reported lower bias than did physicians not working in this specialty. CONCLUSIONS Given existing disparities in harm reduction and addiction treatment services in rural areas, increased physician bias in counties lacking these services suggests that rural patients with opioid use disorder face numerous challenges to finding effective treatment. Bias reduction interventions should target health care professionals in rural communities where such efforts may have the most pronounced impact on improving health care access.
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Affiliation(s)
- Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine (Franz), and Department of Psychology (Dhanani), Ohio University, Athens; College of Public Health, Ohio State University, Columbus (Miller)
| | - Lindsay Y Dhanani
- Department of Social Medicine, Heritage College of Osteopathic Medicine (Franz), and Department of Psychology (Dhanani), Ohio University, Athens; College of Public Health, Ohio State University, Columbus (Miller)
| | - William C Miller
- Department of Social Medicine, Heritage College of Osteopathic Medicine (Franz), and Department of Psychology (Dhanani), Ohio University, Athens; College of Public Health, Ohio State University, Columbus (Miller)
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Cronin CE, Franz B, Choyke K, Rodriguez V, Gran BK. For-profit hospitals have a unique opportunity to serve as anchor institutions in the U.S. Prev Med Rep 2021; 22:101372. [PMID: 33898208 PMCID: PMC8058557 DOI: 10.1016/j.pmedr.2021.101372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 11/22/2022] Open
Abstract
Hospitals serve as anchor institutions in many U.S. communities and make contributions to bolster population health and reduce preventable death. Most studies to date have focused on nonprofit hospitals, but there may be significant opportunity for for-profits to fill this role in both urban and rural communities. Using 2017-2018 data, we calculated descriptive statistics and a multivariate regression model to assess economic and health characteristics for all U.S. counties that contain for-profit as compared to nonprofit or public hospitals (n = 4,622). After controlling for hospital and county characteristics, we found a significant and positive relationship between for-profit hospital presence and higher county unemployment, higher uninsured rates, and the number of residents reporting poor/fair health. For-profit hospitals were also less likely to be located in states that had expanded Medicaid or which had certificate-of-need laws. Our findings suggest that there is substantial opportunity for for-profit hospitals to serve as anchor institutions in many U.S. communities, despite this label more traditionally being applied to nonprofit hospitals. Given that there is not currently a regular reporting mechanism for documenting the community health contributions of for-profit hospitals, policymakers and researchers should evaluate the current state of these contributions and develop incentives to encourage more anchor activities to benefit economically vulnerable communities in the U.S.
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Affiliation(s)
- Cory E. Cronin
- Ohio University, Department of Social and Public Health, Grover W359, Athens, OH 45701, United States
| | - Berkeley Franz
- Ohio University, Heritage College of Osteopathic Medicine, Department of Social Medicine, Grosvenor 311, Athens, OH 45701, United States
| | - Kelly Choyke
- Ohio University, Heritage College of Osteopathic Medicine, Department of Social Medicine, Grosvenor 311, Athens, OH 45701, United States
| | - Vanessa Rodriguez
- Ohio University, Heritage College of Osteopathic Medicine, Department of Social Medicine, Grosvenor 311, Athens, OH 45701, United States
| | - Brian K. Gran
- Case Western Reserve University, Department of Sociology, Mather Memorial Building 224, 10900 Euclid Avenue, Cleveland, OH 44106, United States
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Franz B, Dhanani LY, Brook DL. Physician blame and vulnerability: novel predictors of physician willingness to work with patients who misuse opioids. Addict Sci Clin Pract 2021; 16:33. [PMID: 34034825 PMCID: PMC8147073 DOI: 10.1186/s13722-021-00242-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background Successfully combating the opioid crisis requires patients who misuse opioids to have access to affirming and effective health care. However, there is a shortage of physicians who are willing to work with these patients. We investigated novel predictors of what might be contributing to physicians’ unwillingness to engage with this patient population to better identify and direct interventions to improve physician attitudes. Methods 333 physicians who were board certified in the state of Ohio completed a survey about their willingness to work with patients who misuse opioids. The hypothesized relationships between the proposed predictors and willingness to work with this patient population were tested using multivariate regression, supplemented with qualitative analysis of open-text responses to questions about the causes of addiction. Results Perceptions of personal invulnerability to opioid misuse and addiction, opioid misuse and addiction controllability, and health care provider blame for the opioid crisis were negatively associated with physician willingness to work with patients who misuse opioids after controlling for known predictors of physician bias toward patients with substance use disorders. Physicians working in family and internal medicine, addiction medicine, and emergency medicine were also more willing to work with this patient population. Conclusions Distancing oneself and health care professionals from opioid misuse and placing blame on those who misuse are negatively associated with treatment willingness. Interventions to improve physician willingness to work with patients who misuse opioids can target these beliefs as a way to improve physician attitudes and provide patients with needed health care resources. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00242-w.
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Affiliation(s)
- Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Grosvenor 311, Athens, OH, 45701, USA.
| | - Lindsay Y Dhanani
- Department of Psychology, Ohio University, 22 Richland Avenue, Athens, OH, 45701, USA
| | - Daniel L Brook
- College of Medicine, College of Public Health, The Ohio State University, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
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Franz B, Dhanani LY. Beyond political affiliation: an examination of the relationships between social factors and perceptions of and responses to COVID-19. J Behav Med 2021; 44:641-652. [PMID: 33877532 PMCID: PMC8056796 DOI: 10.1007/s10865-021-00226-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 04/10/2021] [Indexed: 12/18/2022]
Abstract
A significant challenge in the United States’ response to COVID-19 continues to be wide variation in the extent to which individuals believe the virus is a credible health threat and are willing to undertake measures to protect personal and public health. In this study, data were collected from a national sample of 1141 participants from the United States to examine how beliefs and behavioral responses to COVID-19 have been shaped by sociopolitical characteristics. The relationships between social predictors; perceived severity, knowledge, and fear of the virus; and health behaviors were tested using path analysis. Social characteristics significantly predicted perceived severity, knowledge, and fear, as well as health behaviors, even after controlling for an objective indicator of the risk of contracting the virus. Our findings suggest that perceptions and knowledge of the virus, especially believing that the virus poses a serious threat to one’s individual health, are important determinants of behavior, but also that perceptions and knowledge are strongly driven by social and cultural factors above and beyond political affiliation.
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Affiliation(s)
- Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Grosvenor 311, Athens, OH, 45701, USA.
| | - Lindsay Y Dhanani
- Department of Psychology, Ohio University, 22 Richland Avenue, Athens, OH, 45701, USA
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Abstract
Background: The United States has experienced substantial consequences associated with the opioid epidemic. One such consequence has been an increased need for patients who misuse opioids to interface with health care professionals. As such, it is important to understand physician attitudes toward and experiences with this patient population. The goal of this paper is to assess the extent to which physicians hold negative attitudes toward patients who misuse opioids and whether this patient population receives differential treatment. Methods: Using a mixed methods design, we surveyed board-certified physicians in Ohio regarding their attitudes toward patients who misuse opioids as well as their observations of bias toward these patients in health care settings. Results: Our findings suggest that negative attitudes toward patients who misuse opioids are common among physicians as were personal experiences of bias toward this patient population. We also found that physicians rationalized treating these patients differently and perceived barriers to achieving more equitable treatment. Finally, some physicians expressed a desire for additional training and resources to reduce bias. Conclusions: Negative attitudes toward patients who misuse opioids may serve as a critical barrier to patients accessing care in areas heavily affected by the U.S. opioid epidemic.
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Affiliation(s)
| | - Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
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Cronin CE, Franz B, Garlington S. Population health partnerships and social capital: Facilitating hospital-community partnerships. SSM Popul Health 2021; 13:100739. [PMID: 33537403 PMCID: PMC7841352 DOI: 10.1016/j.ssmph.2021.100739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/24/2020] [Accepted: 01/16/2021] [Indexed: 11/24/2022] Open
Abstract
Social capital refers to the social norms and networks that build trust and enable individuals to pursue shared objectives; it can vary considerably between communities and across time. Considerable evidence suggests that the presence of social capital at the local or state level is associated with improved individual health and lower community-level mortality, chronic illness, and diseases of despair such as substance abuse. Social capital may influence health outcomes because community-engaged institutions are more common in communities with strong social bonds and cross-sector partnerships are more easily leveraged. This study examines the impact of social capital on the effectiveness of health care organizations, specifically hospitals, in establishing population health partnerships which are critical for addressing health disparities and reducing preventable deaths. In a national sample of hospitals, we find that in communities with high social capital, hospitals are more likely to hold partnerships with public health and social service agencies. Social capital within communities may create the conditions in which hospitals are able to easily identify possible partnerships and engage in collaborative efforts to improve population health.
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Affiliation(s)
- Cory E. Cronin
- College of Health Sciences and Professions, 1 Ohio University, Athens, OH, 45701, USA
| | - Berkeley Franz
- Heritage College of Osteopathic Medicine, 1 Ohio University, Athens, OH, 45701, USA
| | - Sarah Garlington
- College of Health Sciences and Professions, 1 Ohio University, Athens, OH, 45701, USA
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Dhanani LY, Franz B. Why public health framing matters: An experimental study of the effects of COVID-19 framing on prejudice and xenophobia in the United States. Soc Sci Med 2020; 269:113572. [PMID: 33321405 DOI: 10.1016/j.socscimed.2020.113572] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic has triggered a notable increase in the expression of prejudicial and xenophobic attitudes that threaten the wellbeing of minority groups and contribute to the overall public health toll of the virus. However, while there is evidence documenting the growth in discrimination and xenophobia, little is known about how the COVID-19 outbreak is activating the expression of such negative attitudes. The goal of the current paper therefore was to investigate what aspects of the COVID-19 pandemic may be contributing to this rise in expressions of prejudice and xenophobia. More specifically, this study used an experimental design to assess the effects of using stigmatized language to describe the virus as well as the threat to physical health and economic wellbeing posed by the virus on COVID-19 prejudice. Data were collected from a national sample of 1451 adults residing within the United States. Results from 2 × 2 x 2 between-subjects analyses of covariance demonstrated that emphasizing the connection between China and COVID-19, rather than framing the virus neutrally, increased negative attitudes toward Asian Americans, beliefs that resources should be prioritized for Americans rather than immigrants, and general xenophobia. Emphasizing the severity of the economic impact of the virus also increased beliefs that Asian Americans are a threat to resources and general xenophobia. In contrast, messages which emphasized the serious health risks of COVID-19 did not increase bias toward Asian Americans or xenophobia. Our findings suggest that specific types of public health messaging related to infectious diseases, especially framing the virus in terms of its country of origin or its likely economic impact, may elicit prejudice and xenophobia. Public health campaigns that emphasize the severity of the virus, however, are not likely to trigger the same negative attitudes. Implications for public health responses to health crises are discussed.
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Affiliation(s)
- Lindsay Y Dhanani
- Ohio University, Department of Psychology, 22 Richland Ave, Athens, OH 45701, USA.
| | - Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine, Department of Social Medicine, Athens, OH 45701, USA.
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Cronin CE, Franz B, Pagán JA. Why Are Some US Nonprofit Hospitals Not Addressing Opioid Misuse in Their Communities? Popul Health Manag 2020; 23:407-413. [DOI: 10.1089/pop.2019.0157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cory E. Cronin
- Department of Social and Public Health, Ohio University, Athens, Ohio, USA
| | - Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - José A. Pagán
- Department of Public Health Policy and Management, College of Global Public Health, New York University, New York, New York, USA
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Franz B, Cronin CE, Pagan JA. What Strategies Are Hospitals Adopting to Address the Opioid Epidemic? Evidence From a National Sample of Nonprofit Hospitals. Public Health Rep 2020; 136:228-238. [PMID: 33176117 DOI: 10.1177/0033354920968805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Hospitals are on the front lines of the opioid epidemic, seeing patients who overdose or have complicated infections, but the extent of services offered or whether services are evidence-based is not known. The objective of our study was to assess the extent to which nonprofit hospitals are addressing opioid abuse, a critical public health issue, through their community benefit work and to identify which evidence-based strategies they adopt. METHODS We reviewed community benefit documents from January 1, 2015, through December 31, 2018, for a sample (N = 446) of all nonprofit hospitals in the United States. We classified hospital opioid-related strategies into 9 categories. Using logistic regression, we predicted the likelihood of hospitals adopting various strategies to address opioid abuse. RESULTS Of the 446 nonprofit hospitals in our sample, 49.1% (n = 219) adopted ≥1 clinical strategy to address opioid use disorder in their community. Approximately one-quarter (26.5%; n = 118) of hospitals adopted a strategy related to treatment services for substance use disorder; 28.2% (n = 126) had ≥1 program focused on connecting patients to a primary care medical home, and 14.6% (n = 65) focused on caring for patients with opioid-related overdoses in the emergency department. We also identified factors that predicted involvement in programs that were less common than clinical strategies, but potentially effective, such as harm reduction and prescriber initiatives (both 6.3% of hospitals). CONCLUSIONS Evidence-based prevention and treatment require strong collaboration between health care and community institutions at all levels. Effective policy interventions may exist to encourage various types and sizes of nonprofit hospitals to adopt evidence-based interventions to address opioid abuse in their communities.
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Affiliation(s)
- Berkeley Franz
- 1354 Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Cory E Cronin
- 1354 Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Jose A Pagan
- 5894 Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
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Franz B, Cronin CE, Wainwright A, Lai AY, Pagán JA. Community Health Needs Predict Population Health Partnerships Among U.S. Children's Hospitals. Med Care Res Rev 2020; 78:771-779. [PMID: 33100155 DOI: 10.1177/1077558720968999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cross-sector collaboration is critical to improving population health, but data on partnership activities by children's hospitals are limited, and there is a need to identify service delivery gaps for families. The aim of this study is to use public community benefit reports for all children's hospitals in the United States to assess the extent to which children's hospitals partner with external organizations to address five key health needs: health care access, chronic disease, social needs, mental health, and substance abuse. Strategies that involved partnering with community organizations were most common in addressing social needs and substance abuse. When adjusted for institutional and community characteristics hospitals in a multilevel regression model, hospitals had higher odds of partnering to address chronic illness and social needs. To encourage hospital engagement with complex social and behavioral health needs and promote health equity, support should be provided to help hospitals establish local population health networks.
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Dhanani LY, Franz B. The Role of News Consumption and Trust in Public Health Leadership in Shaping COVID-19 Knowledge and Prejudice. Front Psychol 2020; 11:560828. [PMID: 33192827 PMCID: PMC7642623 DOI: 10.3389/fpsyg.2020.560828] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022] Open
Abstract
The novelty of COVID-19 has created unique challenges to successful public health efforts because it has required the public to quickly learn and formulate knowledge and attitudes about the virus as information becomes available. The need to stay apprised of new information has also created a critical role for mass media and public institutions in shaping the public’s knowledge of, attitudes about, and responses to the unfolding pandemic. In this study, we examine how media consumption and reliance on specific institutions for information shapes three critical outcomes associated with public health epidemics: the accumulation of knowledge and the endorsement of misinformation about COVID-19, and prejudicial responses to the virus. We surveyed 1,141 adults residing across the United States in March 2020. Using multivariate regression and t-tests, we found that participants had greater knowledge, were less likely to endorse misinformation, and reported less bias toward Asian Americans when they had higher trust in the CDC and lower trust in President Trump. Reliance on certain news formats and sources was also associated with knowledge, misinformation, and prejudice. Our findings suggest that trust and news consumption can pose critical barriers to health literacy and foster negative prejudicial responses that further undermine public health efforts surrounding the COVID-19 pandemic.
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Affiliation(s)
- Lindsay Y Dhanani
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United States
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Abstract
Purpose: Racism is an essential factor to understand racial health disparities in infection and mortality due to COVID-19 and must be thoroughly integrated into any successful public health response. But highlighting the effect of racism generally does not go far enough toward understanding racial/ethnic health disparities or advocating for change; we must interrogate the various forms of racism in the United States, including behaviors and practices that are not recognized by many as racism. Methods: In this article, we explore the prevalence and demographic distribution of various forms of racism in the United States and how these diverse racial ideologies are potentially associated with racialized responses to the COVID-19 crisis. Results: We find that among white Americans, more than a quarter express traditional racist attitudes, whereas more than half endorse more contemporary and implicit forms of racist ideology. Each of these types of racism helps us explain profound disparities related to COVID-19. Conclusions: Despite a robust literature documenting persistent patterns of racial disparities in the United States, a focus on the role that various forms of racism play in perpetuating these disparities is absent. These distinctions are essential to realizing health equity and countering disparities in COVID-19 and other health outcomes among people of color in the United States.
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Affiliation(s)
- Adrienne Milner
- Department of Health Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
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Franz B, Cronin CE, Wainwright A, Pagán JA. Measuring Efforts of Nonprofit Hospitals to Address Opioid Abuse After the Affordable Care Act. J Prim Care Community Health 2020; 10:2150132719863611. [PMID: 31387443 PMCID: PMC6686324 DOI: 10.1177/2150132719863611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To assess the strategies that nonprofit hospitals are adopting to address opioid abuse after requirements for community engagement expanded in the Affordable Care Act. Methods: We constructed a dataset of implementation activities for a 20% random sample of nonprofit hospitals in the United States. Using logistic regression, we assessed the extent to which strategies adopted are new, existing, or primarily partnerships. Using negative binomial regression, we assessed the total number of strategies adopted. We controlled for hospital and community characteristics as well as state policies related to opioid abuse. Results: Most strategies adopted by hospitals were new and clinical in nature and the most common number of strategies adopted was one. Hospitals in the Northeast were more likely to adopt a higher number of strategies and to partner with community-based organizations. Hospitals that partner with community-based organizations were more likely to adopt strategies that engage in harm reduction, targeted risk education, or focus on addressing social determinants of health. Conclusions: Community, institutional, and state policy characteristics predict hospital involvement in addressing opioid abuse. These findings underscore several opportunities to support hospital-led interventions to address opioid abuse.
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Affiliation(s)
- Berkeley Franz
- 1 Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Cory E Cronin
- 2 College of Health Sciences & Professions, Ohio University, OH, USA
| | | | - José A Pagán
- 4 College of Global Public Health, New York University, New York, NY, USA
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Franz B, Cronin CE. Are Children's Hospitals Unique in the Community Benefits They Provide? Exploring Decisions to Prioritize Community Health Needs Among U.S. Children's and General Hospitals. Front Public Health 2020; 8:47. [PMID: 32175301 PMCID: PMC7056662 DOI: 10.3389/fpubh.2020.00047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/10/2020] [Indexed: 11/13/2022] Open
Abstract
The Affordable Care Act expanded community benefit requirements for nonprofit hospitals, which now must demonstrate that they take into account the needs of their surrounding community in deciding where to make community benefit investments. No study to date has assessed the Community Health Needs Assessments (CHNAs) of a large sample of nonprofit hospitals to understand how hospitals determine the priority health needs that they include for their community or how prioritized health needs differ between general and children's hospitals. We analyzed the CHNAs of a 20% random sample of general hospitals in the United States as well as all children's hospitals. After identifying the five most common needs across all hospitals-mental health, substance misuse, social needs, chronic illness, and access to care-we used descriptive statistics and multivariate logistic regression to determine which hospitals were most likely to prioritize each of these five needs in their CHNA and the organizational, county, and regional factors associated with prioritizing a need. We found that children's hospitals were more likely than general hospitals to prioritize each of these five needs in their CHNA and that related county-level health indicators were significantly associated with hospitals prioritizing social needs and substance misuse as top needs in their CHNAs. County-level demographic variation, such as the percentage of white residents, and regional location were significantly related to whether hospitals prioritized a need in their CHNA. Our results suggest that children's hospitals are more likely to include a similar list of health issues on their CHNAs and that factors beyond county-level health indicators (e.g., organizational mission, regional health indicators, etc.) are operative in hospital decisions to include needs on their CHNAs.
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Affiliation(s)
- Berkeley Franz
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United States
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Cronin CE, Franz B, Schuller KA. Expanding the Population Health Workforce: Strategic Priorities of Hospital Organizations in the United States. Popul Health Manag 2020; 24:59-68. [PMID: 32155088 DOI: 10.1089/pop.2019.0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The role of hospital contributions to population health is a topic increasingly worthy of attention in the years since the Affordable Care Act. To explore how hospitals themselves consider their role as population health leaders, the authors analyzed data from the 2015 American Hospital Association Annual Population Health Survey, which asks organizations about which strategic priorities should be expanded in order to strengthen their organization's population health workforce. Descriptive statistics for the study sample of 1418 hospitals show that physicians were the most commonly ranked priority, followed by behavioral health professionals. Using multivariate analysis, the professional roles identified were grouped into 5 categories: behavioral health, clinical, data collection, business functions, and social supports and services. Doing so revealed that different types of hospitals were more likely to identify different types of roles as more important. Larger hospitals were more likely than others to identify behavioral health and clinical roles. For-profit hospitals were less likely to prioritize data collection and social determinants than their nonprofit peers. These findings provide important insight for public health professionals regarding the staffing priorities of hospitals within their communities. Many population health programs may not be moving beyond traditional clinical expertise to engage the upstream determinants of health in their communities.
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Affiliation(s)
- Cory E Cronin
- College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - Berkeley Franz
- Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Kristin A Schuller
- College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
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Franz B, Murphy JW. What role should philosophy play in community-based health services? J Eval Clin Pract 2019; 25:970-976. [PMID: 31037795 DOI: 10.1111/jep.13148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/24/2019] [Accepted: 03/28/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Berkeley Franz
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - John W Murphy
- Department of Sociology, University of Miami, Coral Gables, Florida
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Franz B, Cronin CE, Skinner D, Pagán JA. Do State Opioid Policies Influence Nonprofit Hospitals' Decisions to Address Substance Abuse in Their Communities? Med Care Res Rev 2019; 78:371-380. [PMID: 31583961 DOI: 10.1177/1077558719880090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The U.S. epidemic of opioid abuse calls for broad collaboration between a wide range of health care institutions and the various levels of government. Through the community benefit programs they provide, nonprofit hospitals are well positioned to be key partners in local efforts. Although substance abuse appears on approximately 90% of the most recent community health needs assessments completed by hospitals, many hospitals are not addressing substance abuse in their programmatic efforts. Given wide state variation in policies to combat opioid abuse, we assess whether state leadership to address the opioid crisis influences hospital decisions to invest in substance abuse programs. Our findings suggest that several key state policies are related to hospital investments in substance abuse initiatives. To capitalize on the community benefit responsibilities of local hospitals, policies that provide specific direction for and engagement with local hospitals may increase cooperation and investments to address substance abuse.
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Abstract
In the past few decades, scholars have begun to establish ethical principles for public health engagement. A key tension has been how to reconcile public health improvement with local autonomy in decision making so as to express respect for community members' on-the-ground experience. This article describes the experience of one children's hospital in learning to ethically engage a surrounding community in conversations about housing development in partnership with a local faith-based development organization.
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Affiliation(s)
- Daniel Skinner
- An assistant professor of health policy at the Ohio University Heritage College of Osteopathic Medicine in Dublin, Ohio, and a co-director of the Health Policy Fellowship, a program of the American Association of Colleges of Osteopathic Medicine
| | - Berkeley Franz
- A medical sociologist and an assistant professor of community-based health at the Ohio University Heritage College of Osteopathic Medicine in Athens, Ohio
| | - Kelly Kelleher
- A professor of pediatrics at the Ohio State University College of Medicine and the director of the Center for Innovation in Pediatric Practice and the vice president of health services research at the Research Institute at Nationwide Children's Hospital
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